=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376179788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARBOR PLACE DENTAL GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2020
-----------------------------------------------------
Last Update Date | 03/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4904 TIMBER RIDGE DR STE 304
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30135-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-838-9600
-----------------------------------------------------
Fax | 678-838-4149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4904 TIMBER RIDGE DR STE 304
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30135-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-838-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. ROBIN MARIE JONES
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 404-210-0063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------